O efeito da oxigenoterapia hiperbárica na cicatrização da anastomose esofagojejunal em ratos

Objetivo: Avaliar o efeito da oxigenoterapia hiperbárica na cicatrização da anastomose esôfagojejunal em ratos gastrectomizados. Métodos: 40 ratos Wistar, adultos machos, pesando entre 322g e 506g, foram divididos aleatoriamente em dois grupos. No grupo A (grupo controle) 20 ratos foram submetidos à gastrectomia total. No grupo B, 20 ratos foram gastrectomizados e receberam tratamento pós-operatório com oxigênio hiperbárico, 90 minutos/dia durante sete dias. Todos os ratos foram sacrificados no oitavo dia pós-operatório e avaliados de acordo com as seguintes variáveis: a) presença de fístula anastomótica; b) avaliação da cicatrização da anastomose esôfagojejunal pela medida da força de ruptura à tração na linha da sutura conforme Hendriks & Mastboom; c) determinação da concentração de colágeno na anastomose pelos critérios de Kovács. Para análise estatística comparativa entre os grupos foi utilizado o teste “t” de Student, considerando-se como significativo o valor de p=0.05. Resultados: A mortalidade foi de 20%. Morreram cinco ratos do grupo A e tres do grupo B (p= N.S.). Ocorreu uma fístula anastomótica em cada grupo não relacionadas a óbito. A medida da força de ruptura à tração na linha da sutura (p= 0.528) e a determinação da concentração de colágeno na anastomose esôfagojejunal (p= 0.89) não mostrou diferença estatisticamente significativa entre os grupos A e B. Conclusão: A oxigenoterapia hiperbárica não interferiu no processo de cicatrização da anastomose esôfagojejunal.Purpose: To evaluate hyperbaric oxygen therapy (HBO) after esophagojejunal anastomosis in a rat experimental model and the effect of HBO on the healing of esophagojejunal anastomosis in gastrectomized rats. Methods: Forty adult male Wistar rats, weighing 322 g to 506 g, were divided into two random groups. In group A (control group), 20 rats were subjected to total gastrectomy. In group B, 20 rats were similarly gastrectomized, but also received postoperative HBO treatment for 90 minutes/day for seven days. All rats were sacrificed on the eighth postoperative day and evaluated according to the following study variables: a) presence of anastomotic fistula; b) evaluation of esophagojejunal anastomosis healing by measuring the breaking strength at the suture line as per Hendriks & Mastboom; and c) determining the collagen concentration in the anastomosis, as per Kovács criteria. For the comparative statistical analysis between groups, Student’s “t” test was used. A value of p<0.05 was considered significant. Results: There was a 20% mortality rate. There were five deaths in group A and three in group B (p=N.S.). There was only one anastomotic fistula in each group, and neither caused any morbidity or death. Breaking strength measured at the suture line (p=0.528) and collagen concentration determined at the esophagojejunal anastomosis (p=0.89) were not significantly different between Groups A and B. Conclusion: Hyperbaric oxygen therapy did not affect the healing process of esophagojejunal anastomosis

O efeito da oxigenoterapia hiperbárica na cicatrização da anastomose esofagojejunal em ratos

Objetivo: Avaliar o efeito da oxigenoterapia hiperbárica na cicatrização da anastomose esôfagojejunal em ratos gastrectomizados. Métodos: 40 ratos Wistar, adultos machos, pesando entre 322g e 506g, foram divididos aleatoriamente em dois grupos. No grupo A (grupo controle) 20 ratos foram submetidos à gastrectomia total. No grupo B, 20 ratos foram gastrectomizados e receberam tratamento pós-operatório com oxigênio hiperbárico, 90 minutos/dia durante sete dias. Todos os ratos foram sacrificados no oitavo dia pós-operatório e avaliados de acordo com as seguintes variáveis: a) presença de fístula anastomótica; b) avaliação da cicatrização da anastomose esôfagojejunal pela medida da força de ruptura à tração na linha da sutura conforme Hendriks & Mastboom; c) determinação da concentração de colágeno na anastomose pelos critérios de Kovács. Para análise estatística comparativa entre os grupos foi utilizado o teste “t” de Student, considerando-se como significativo o valor de p=0.05. Resultados: A mortalidade foi de 20%. Morreram cinco ratos do grupo A e tres do grupo B (p= N.S.). Ocorreu uma fístula anastomótica em cada grupo não relacionadas a óbito. A medida da força de ruptura à tração na linha da sutura (p= 0.528) e a determinação da concentração de colágeno na anastomose esôfagojejunal (p= 0.89) não mostrou diferença estatisticamente significativa entre os grupos A e B. Conclusão: A oxigenoterapia hiperbárica não interferiu no processo de cicatrização da anastomose esôfagojejunal.Purpose: To evaluate hyperbaric oxygen therapy (HBO) after esophagojejunal anastomosis in a rat experimental model and the effect of HBO on the healing of esophagojejunal anastomosis in gastrectomized rats. Methods: Forty adult male Wistar rats, weighing 322 g to 506 g, were divided into two random groups. In group A (control group), 20 rats were subjected to total gastrectomy. In group B, 20 rats were similarly gastrectomized, but also received postoperative HBO treatment for 90 minutes/day for seven days. All rats were sacrificed on the eighth postoperative day and evaluated according to the following study variables: a) presence of anastomotic fistula; b) evaluation of esophagojejunal anastomosis healing by measuring the breaking strength at the suture line as per Hendriks & Mastboom; and c) determining the collagen concentration in the anastomosis, as per Kovács criteria. For the comparative statistical analysis between groups, Student’s “t” test was used. A value of p<0.05 was considered significant. Results: There was a 20% mortality rate. There were five deaths in group A and three in group B (p=N.S.). There was only one anastomotic fistula in each group, and neither caused any morbidity or death. Breaking strength measured at the suture line (p=0.528) and collagen concentration determined at the esophagojejunal anastomosis (p=0.89) were not significantly different between Groups A and B. Conclusion: Hyperbaric oxygen therapy did not affect the healing process of esophagojejunal anastomosis

Effect of hyperbaric oxygen therapy on esophagojejunal anastomosis healing in rats O efeito da oxigenoterapia hiperbárica na cicatrização da anastomose esofagojejunal em ratos

PURPOSE: To evaluate hyperbaric oxygen therapy (HBO) after esophagojejunal anastomosis in a rat experimental model and the effect of HBO on the healing of esophagojejunal anastomosis in gastrectomized rats. METHODS: Forty adult male Wistar rats, weighing 322 g to 506 g, were divided into two random groups. In group A (control group), 20 rats were subjected to total gastrectomy. In group B, 20 rats were similarly gastrectomized, but also received postoperative HBO treatment for 90 minutes/day for seven days. All rats were sacrificed on the eighth postoperative day and evaluated according to the following study variables: a) presence of anastomotic fistula; b) evaluation of esophagojejunal anastomosis healing by measuring the breaking strength at the suture line as per Hendriks & Mastboom; and c) determining the collagen concentration in the anastomosis, as per Kovács criteria. For the comparative statistical analysis between groups, Student's "t" test was used. A value of p<0.05 was considered significant. RESULTS: There was a 20% mortality rate. There were five deaths in group A and three in group B (p=N.S.). There was only one anastomotic fistula in each group, and neither caused any morbidity or death. Breaking strength measured at the suture line (p=0.528) and collagen concentration determined at the esophagojejunal anastomosis (p=0.89) were not significantly different between Groups A and B. CONCLUSION: Hyperbaric oxygen therapy did not affect the healing process of esophagojejunal anastomosis.<br>OBJETIVO: Avaliar o efeito da oxigenoterapia hiperbárica na cicatrização da anastomose esôfagojejunal em ratos gastrectomizados. MÉTODOS: 40 ratos Wistar, adultos machos, pesando entre 322g e 506g, foram divididos aleatoriamente em dois grupos. No grupo A (grupo controle) 20 ratos foram submetidos à gastrectomia total. No grupo B, 20 ratos foram gastrectomizados e receberam tratamento pós-operatório com oxigênio hiperbárico, 90 minutos/dia durante sete dias. Todos os ratos foram sacrificados no oitavo dia pós-operatório e avaliados de acordo com as seguintes variáveis: a) presença de fístula anastomótica; b) avaliação da cicatrização da anastomose esôfagojejunal pela medida da força de ruptura à tração na linha da sutura conforme Hendriks & Mastboom; c) determinação da concentração de colágeno na anastomose pelos critérios de Kovács. Para análise estatística comparativa entre os grupos foi utilizado o teste "t" de Student, considerando-se como significativo o valor de p=0.05. RESULTADOS: A mortalidade foi de 20%. Morreram cinco ratos do grupo A e tres do grupo B (p= N.S.). Ocorreu uma fístula anastomótica em cada grupo não relacionadas a óbito. A medida da força de ruptura à tração na linha da sutura (p= 0.528) e a determinação da concentração de colágeno na anastomose esôfagojejunal (p= 0.89) não mostrou diferença estatisticamente significativa entre os grupos A e B. CONCLUSÃO: A oxigenoterapia hiperbárica não interferiu no processo de cicatrização da anastomose esôfagojejunal

D-MELD does not predict post-liver transplantation survival: a single-center experience from Brazil

Background. The D-MELD score was designed to prevent donor-recipient matches with a high risk of unfavorable outcome. The main objective of the present study was to assess the predictive value of the D-MELD score for 1-month and 3-month post-transplant mortality in a cohort of patients who underwent deceased-donor liver transplantation in Southern Brazil.Material and methods. A cohort study was conducted. Receiver operating characteristic c-statistics were used to determine the ability of the D-MELD score to predict mortality. The Kaplan-Meier method was used to analyze survival as a function of time regarding D-MELD scores, and the Cox model was employed to assess the association between D-MELD and mortality.Results. Most recipients were male, with a mean age of 54.3 ± 9.6 years (n = 233 transplants). Mean donor age was 44.9 ± 16.8 years (19.3% of donors were aged ≥ 60 years). Mean MELD and D-MELD scores were 16.3 ± 7.1 and 733.1 ± 437.8 respectively. Overall survival at 1 and 3 months was 83.6%. The c-statistic value for 1- and 3-month mortality was < 0.5 for the D-MELD. Analysis of Kaplan-Meier curves for groups with D-MELD scores < 1,600 and ≥ 1,600 did not show statistically significant differences in survival (p = 0.722).Conclusion. D-mElD scores were unable to predict survival in this cohort of Brazilian liver transplant recipients

Liver retransplantation in adults: a 20–year experience of one center in southern Brazil

Introduction. Liver retransplantation (LReTx) is the therapeutic option for hepatic graft failure. Survival after LReTx is poorer than after primary liver transplantation. Given the organ shortage, it is essential to optimize the use of this resource.Objective. To evaluate rates, indications and patient survival after LReTx and identify factors associated with mortality following LReTx.Material and methods. We conducted a retrospective cohort study of all adults undergoing LReTx based on registry data from the Liver Transplantation Group (Complexo Hospitalar Santa Casa de Porto Alegre), southern Brazil.Results. Between June 16, 1991 and July 19, 2011, 824 patients underwent 866 liver transplants. Forty-two procedures corresponded to LReTx (4.8% of all liver transplants performed). Thirty-eight patients who underwent a single LReTx procedure were included in this study. The leading indication for LReTx was hepatic artery thrombosis (HAT) (31.6%), followed by primary nonfunction (PNF) (18.4%). The main indication for early LReTx was PNF (58.3%) and for late LReTx was HAT (38.5%). During the follow-up period, 26 patients (68.4%) died after LReTx. Patient survival at 1 and 3 years after LReTx was 44.7% and 44.7%, respectively. Patients infected with hepatitis C virus, serum albumin < 2.5 g/dL and receiving mechanical ventilation immediately before LReTx had a significantly lower survival rate than the other patients.Conclusion. Considering the increased mortality when the graft loss is delayed, it is necessary to define the minimum acceptable results to indicate LReTx and identify the patients who would most benefit from this treatment